New Five-Star Rating for Home Health Agencies

The Centers for Medicare and Medicaid Services (CMS) has just issued a five-star rating system under Medicare to rate the quality of services home health agencies provide to their patients. The Quality of Patient Care Star Rating system allows consumers the opportunity to evaluate and compare home health care agencies’ quality of services. Understanding the rating system and criteria used to grade an agency’s services is necessary to receive a good rating from CMS.

Below are the nine criteria CMS uses to rate home health agencies:

  • Timely Initiation of Care
  • Drug Education on all Medications Provided to Patient/Caregiver
  • Influenza Immunization Received for Current Flu Season
  • Improvement in Ambulation
  • Improvement in Bed Transferring
  • Improvement in Bathing
  • Improvement in Pain Interfering With Activity
  • Improvement in Shortness of Breath
  • Acute Care Hospitalization

All home health agencies that are Medicare-certified are potentially eligible to receive a star rating. Agencies must have at least 20 complete quality episodes for data for each measure above. A completed episode of care starts when a patient is admitted to a home health agency (or the patient’s care is resumed following an inpatient facility stay) and ends when discharged or transferred to an inpatient facility. Agencies must report data for 5 of the 9 measures listed above to have a Quality of Patient Care Star Rating calculated. CMS will update the ratings quarterly based on new data published on the Home Health Compare website.

The following short list contains only a few of the extensive criteria used to determine the measures listed above. Improvements in these areas will improve an agency’s star rating.

Improvement measures – measures describing a patient’s ability to get around, perform activities of daily living, and general health

Measures of potentially avoidable events – markers for potential problems in care

Utilization of care measures – measures describing how often patients access other health care resources either while home health care is in progress or after home health care is completed. There are 4 claims-based utilization measures currently used: Acute Care Hospitalization (ACH); Emergency Department (ED) Use without Hospitalization; Re-hospitalization during the First 30 Days of Home Health (Re-hospitalization); ED Use without Hospital Readmission During the First 30 Days of Home Health (ED Use without Hospital Readmission)

Outcome and Assessment Information Set (OASIS) – data collected from home health agencies for their completed episodes, including timeliness of home care admission, immunizations, use of risk assessment tools for falls, pain, depression, pressure ulcer development, measures for specific diagnoses (heart failure, diabetes, pressure ulcers) and measures of care planning and clinical interventions delivered for patients experiencing certain symptoms

The home health care industry is becoming more and more competitive. Improving an agency’s rating is crucial to increasing census and staying viable. A full list of criteria can be found on the Centers for Medicare and Medicaid Services’ website. If your agency has any further questions, contact Ted McGinn at (847) 705-9833 or tmcginn@lavellelaw.com.